Klimek L, Chaker A, Deitmer T, Plontke S K, Wollenberg B, Bousquet J, Bachert C
Allergiezentrum Rheinland-Pfalz, Universitätsmedizin Mainz, Wiesbaden, Deutschland.
Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland.
HNO. 2021 Nov;69(11):868-877. doi: 10.1007/s00106-021-01018-z. Epub 2021 Mar 18.
For patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) which cannot be controlled by continuous therapy with intranasal corticosteroids (INCS) and systemic corticosteroids and/or surgical treatment, there were no approved curative options for a long time. For CRSwNP treatment with T2-addressing biologics is possible. On October 24, 2019, the European Commission granted extended approval for dupilumab as the first biological agent for treatment of insufficiently controlled severe CRSwNP. The Federal Joint Committee (G‑BA) evaluates the benefits of reimbursable drugs with new active ingredients. This includes assessment of the additional benefit and its therapeutic relevance.
A meta-analysis was performed using individual patient data based on two phase III studies. Both studies examined the safety and efficacy of dupilumab as an add-on therapy to INCS for treatment of CRSwNP in adults inadequately controlled with systemic corticosteroids and/or surgery compared to INCS alone.
Based on the present data, the G‑BA decided that there is an indication of a considerable additional benefit of dupilumab compared to mometasone furoate.
For patients with severe CRSwNP inadequately controlled with INCS and systemic corticosteroids and/or surgery, there is an indication of a considerable additional benefit for the administration of dupilumab as an add-on therapy to INCS compared to mometasone furoate alone.
对于严重慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者,若经鼻内糖皮质激素(INCS)及全身用糖皮质激素持续治疗和/或手术治疗仍无法控制病情,长期以来一直没有获批的治愈方案。使用针对2型炎症的生物制剂治疗CRSwNP是可行的。2019年10月24日,欧盟委员会批准度普利尤单抗扩大适应症,作为首个用于治疗控制不佳的重度CRSwNP的生物制剂。德国联邦联合委员会(G-BA)评估具有新活性成分的可报销药物的益处。这包括对额外获益及其治疗相关性的评估。
基于两项III期研究,使用个体患者数据进行荟萃分析。两项研究均考察了度普利尤单抗作为INCS的附加疗法,用于治疗经全身用糖皮质激素和/或手术治疗控制不佳的成人CRSwNP患者的安全性和有效性,并与单用INCS进行比较。
基于现有数据,G-BA判定,与糠酸莫米松相比,度普利尤单抗具有显著的额外获益。
对于经INCS及全身用糖皮质激素和/或手术治疗控制不佳的重度CRSwNP患者,与单用糠酸莫米松相比,度普利尤单抗作为INCS的附加疗法给药具有显著的额外获益。